Anyone who has been through menopause can attest that symptoms such as hot flashes, vaginal dryness, mood swings and insomnia can wreak havoc on your well-being. Some women even develop a sort of brain fog and have trouble remembering where they left their keys.
“Some of these changes are age-related,” says Janet Weatherly, certified nurse midwive and menopause women’s health practitioner at Henry Ford Health. “But others are a direct result of changing hormone levels.” While there’s no doubt that hormone replacement therapy (HRT) is remarkably effective at obliterating troubling symptoms, flip-flopping recommendations regarding HRT’s safety have left many women baffled about how to get relief.
HRT Controversy Explained
In 2002, results from a national study called the Women’s Health Initiative (WHI) reported that HRT could increase the risk of heart disease, stroke and breast cancer in women who took a type of estrogen and a synthetic progestin for more than five years. The news created a great deal of concern, but the study has since been reevaluated.
“The study focused on women over 60, not newly menopausal women,” Weatherly says. The media played a huge role in misrepresenting the data. In fact, the latest research suggests that for women under age 60, not taking HRT can increase the risk of developing heart disease and osteoporosis.
Myths About Menopause and HRT
Unfortunately, many women with debilitating menopausal symptoms have been suffering unnecessarily in the wake of the WHI study. The good news: getting relief now may be easier – and safer – than you think.
Here, Weatherly dispels the top six misconceptions about menopausal treatments:
- Myth: HRT increases your risk of heart disease. A huge segment of the 2002 study participants – 70 percent – were over age 60 and more than a decade past menopause. And they all took only one type of HRT — a combination of estrogen and synthetic progestin called Prempro. So, when the WHI reported that women using HRT were at greater risk for heart attacks, strokes and breast cancer, those results only applied to older women taking Prempro. In fact, the WHI reported in 2011 and 2012 that women who received only estrogen (conjugated equine estrogen-Premarin) and no synthetic progestin had fewer deaths each year for 10 years and were less likely to develop breast cancer and heart disease compared to those who received a placebo.
- Myth: Oral HRT is the only effective treatment for menopausal symptoms. Newer hormone formulations – including those with lower doses and transdermal routes of delivery as well as FDA-approved bioidentical hormone regimens – offer effective relief of menopausal symptoms for many women and come with fewer side effects.
- Myth: Women who enter menopause early should avoid HRT. More than two-thirds of women hit menopause before age 50. For this group, initiating HRT early can be a lifesaving strategy. A 2012 analysis reported that women who started HRT within 10 years of menopause had a 30 percent lower mortality rate and 48 percent lower risk of heart disease compared to women who took a placebo.
- Myth: There’s only one type of HRT. Women today can choose from more than 50 types of HRT. Newer forms of HRT contain estradiol and progesterone – the very same molecules that women’s bodies produce naturally. These range from oral formulations to topical applications, which can be used alone or in combination. For example, women who only suffer from genital and urinary issues may find relief with transdermal or vaginal estrogen combined with low-dose oral estrogen.
- Myth: Bioidentical compounded hormones are safer than FDA-approved pharmaceuticals. Many women buy “natural” hormones or bioidentical hormones compounded at special pharmacies because they think they’re safe. But because production of compounded bioidentical formulations is not subject to the same scrutiny as traditional FDA-approved HRT, their dosage and effectiveness may be inaccurate. The good news is that the FDA has also approved bioidentical hormone formulations – and they’re far less expensive than the non-approved type. Any product that is bioidentical carries the same benefits and risks as FDA-approved hormone therapies produced by pharmaceutical companies.
- Myth: Lifestyle strategies don’t work. For some lucky women, adopting certain lifestyle habits is enough to relieve menopausal symptoms. Proper sleep, nutrition, exercise and stress management strategies can help minimize nuisances such as hot flashes, brain fog and depression. Dressing in layers and steering clear of triggers (such as spicy food, red wine and certain food additives like monosodium glutamate, or MSG) can help cool down hot flashes.
All women, regardless of age or health status, must carefully weigh the risks and benefits and share in the decision-making with their health care provider. Some women may be able to sidestep HRT altogether by implementing certain lifestyle strategies. Nonetheless, for most women, menopause is a transition and symptoms will settle down and ultimately subside over time.
Janet Weatherly, CNM, works with women experiencing menopause at Henry Ford Health Center – Fraser and Henry Ford Macomb Medical Pavilion in Clinton Township.